Date of Award

12-2011

Document Type

Independent Study

Degree Name

Master of Science (MS)

Abstract

Emergence Delirium: Modifying risk factors in pediatric patients

Emergence delirium is a known post-operative phenomenon that is more prevalent in the pediatric population, especially preschool children (Chen, Li, Hu, & Wang, 2010). According to Scott and Gold (2006), "Emergence delirium is a clinical condition in which patients are "awake" but experience alterations in disorientation and other mental status changes that range from confusion and lethargy to violent and harmful behavior" (p. 100). The underlying cause of emergence delirium is not fully understood. Knowledge of risk factors that may lead to emergence delirium will assist anesthesia providers in offering an anesthetic that will avoid this detrimental phenomenon

The purpose of this independent project is to identify factors associated with increased incidence of post anesthesia emergence delirium in a pediatric ( 1-6 years) population. A comprehensive review of the literature was performed using PubMed and CINAHL databases. Current research findings on the topic of interest and related topics were reviewed. Roy's adaptation model was used as a theoretical framework

The cause of emergence delirium is not fully understood. Several risk factors have been identified specific to pediatric patients. Even though there are conflicting results on the efficacy of interventions, it is clear that some method of prevention should be used in pediatric patients to prevent emergence delirium

Anesthesia providers can take the knowledge of risk factors into consideration when formulating their anesthetic plan in order to reduce the incidence of this phenomenon in the pediatric population. A decreased incidence of emergence delirium will lead to a decreased cost of post-operative care

Providing anesthesia care to the pediatric population often poses challenges for the Certified Registered Nurse Anesthetist (CRNA) and other anesthesia providers. Pediatric patients are not simply small adults. They differ in their anatomy and physiology, psychology, and pharmacology (Nagelhout & Plaus, 2010). Emergence delirium is a postoperative phenomenon that occurs most often in pediatric patients under 6 years of age with as many as 25-80% of all pediatric patients experiencing some sort of agitation postoperatively (Nagelhout & Plaus, 2010). Post anesthesia emergence delirium includes behaviors such as Non purposeful restlessness, crying, moaning, incoherence, and disorientation in the immediate postoperative period (Nagelhout & Plaus, 2010). These behaviors increase the amount of time a patient spends in the post anesthesia care unit, which leads to increased nursing hours, cost of care, and results in undue stress to both the patient and the parents. A pathologic cause of emergence delirium has not yet been identified and continues to be a phenomenon that is not well understood. Even though emergence delirium is usually self-limiting, the negative effects that it has on patients are real, dangerous, and have the potential to result in physical harm (Lee et al. , 2010). It is imperative that anesthesia providers strive to reduce the potential for these negative outcomes. The clinical questions to be answered in this project include what the risk factors are associated with increased incidence of post anesthesia emergence delirium in a pediatric ( 1-6 years) patient population and what are some interventions that can be utilized to decrease these risk factors. It is important to answer the first clinical question before trying to find answers to the second. This poses a challenge in itself as there is difficulty in finding an absolute cause of emergence delirium.

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